Physiology - respiratory Flashcards

1
Q

What is internal respiration?

A

The intracellular mechanisms which consume oxygen and produce carbon dioxide

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2
Q

What is external respiration?

A

The sequence of events that lead to the exchange of oxygen and carbon dioxide between the external environment and the cells of the body

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3
Q

What are the 4 steps of external respiration?

A

1 - ventilation (gas exchange between atmosphere and alveoli)
2 - gas exchange between alveoli blood
3 - gas transport in the blood
4 - gase exchange between the blood and tissues

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4
Q

What is Boyle’s law?

A

At any constant temperature the pressure exerted by a gas varies inversely with the volume of the gas - as the volume of a gas increases the pressure exerted by the gas decreases

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5
Q

The intra-alveolar pressure must become less than atmospheric pressure for air to flow into the lungs during inspiration. How is this achieved?

A

Before inspiration the intra-alveolar pressure is equal to atmospheric pressure. During inspiration the thorax and lungs expand as a result of contraction of inspiratory muscles causing the intra-alveolar pressure to fall (the air molecules become contained in a larger volume)

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6
Q

What are the 2 forces that hold the thoracic wall and the lungs in close opposition?

A

1) the intrapleural fluid cohesiveness

2) the negative intrapleural pressure

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7
Q

What muscle causes the volume of the thorax to increase vertically?

A

Contraction of the diaphragm

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8
Q

What muscle controls the bucket handle mechanism?

A

External intercostal muscles lifts the ribs and moves the sternum out

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9
Q

How does expiration come about?

A

Passive process brought about by relaxation of inspiratory muscles - the chest wall and lungs recoil to their preinspiration size
This recoil causes the intra-alveolar pressure to rise which forces air to leave the lungs until the intra-alveolar pressure becomes equal to the atmospheric pressure

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10
Q

Why does lung collapse occur in pneumothorax?

A

Air escapes into the pleural space which can abolish the transmural gradient causing the lung to collapse

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11
Q

What causes the lungs to recoil during expiration?

A

Elastic connective tissue in the lungs and the alveolar surface tension

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12
Q

Smaller alveoli have a higher tendency to collapse, according to what law?

A

LaPlace law

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13
Q

What prevents smaller alveoli from collapsing?

A

Pulmonary surfactant - secreted by type II alveoli
It lowers alveolar surface tension (lowers the surface tension of smaller alveoli more than larger alveoli)
This prevents the smaller alveoli from collapsing and emptying their air contents into the larger alveoli

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14
Q

Why does respiratory distress syndrome of the new born happen in premature babies?

A

Developing fetal lungs cannot make surfactant until late in pregnancy so premature babies may not have enough surfactant to combat the alveolar surface tension
Baby will make very strenuous inspiratory efforts to try and overcome the high surface tension and inflate the lungs

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15
Q

What is another factor that helps keep the alveoli open?

A

Alveolar interdependence - if an alveolus starts to collapse, the surrounding alveoli are stretched and then recoil which exerts expanding forces in the collapsing alveoli to open it

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16
Q

In summary, what forces keep the alveoli open and what promote closure of alveoli?

A

Open - transmural pressure gradient, pulmonary surfactant and alveolar interdependence
Closed - elasticity of stretched lung connective tissue, alveolar surface tension

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17
Q

What are the major inspiratory muscles?

A

Diaphragm and external intercostal muscles

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18
Q

What are the accessory muscles of inspiration?

A

Sternocleidomastoid, scalenus and pectoral muscles

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19
Q

What are the muscles of active expiration?

A

Abdominal muscles and internal intercostal muscles

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20
Q

Volume of air entering or leaving the lungs during a single breath. What lung volume is this and what is it’s average value?

A

Tidal volume, typically 0.5L

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21
Q

What is the inspiratory reserve volume (IRV)?

A

Extra volume of air that can be maximally inspired over and above the typical resting tidal volume, typically 3L

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22
Q

What is the expiratory reserve volume (ERV)?

A

Extra volume of air that can be maximally expired beyond the normal volume of air after a resting tidal volume, typically 1L

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23
Q

What is the residual volume (RV)?

A

Minimum volume of air remaining in the lungs even after a maximal expiration, typically 1.2L

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24
Q

What is the inspiratory capacity?

A

Maximum volume of air that can be inspired at the end of a normal quiet expiration (IC = IRV +TV), typically 3.5L

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25
Q

Volume of air in the lungs at the end of normal passive expiration. What is this lung volume and what is it’s average value?

A

Functional residual capacity (FRC = ERV + RV), typically 2.2L

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26
Q

What is the vital capacity?

A

Maximum volume of air that can be moved out during a single breath following a maximal inspiration (VC = IC (IRV + TV) + ERV), typically 4.5L

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27
Q

What is the total lung capacity?

A

Total volume of air the lungs can hold

TLC = VC + RV, typically 5.7L

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28
Q

When would the residual volume increase?

A

When the elastic coil of the lungs is lost e.g. in emphysema

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29
Q

What is the FVC?

A

Forced vital capacity - maximum volume that can be forcibly expelled from the lungs following a maximal inspiration

30
Q

What is the FEV1?

A

Forced expiratory volume in one second - volume of air that can be expired during the first second of expiration in an FVC determination

31
Q

What is a healthy FEV1/FVC ratio normally?

A

> 70%

32
Q

What happens to the FEV1/FVC ratio in obstructive lung disease and why is this?

A

<70% because the FVC is normal or low and the FEV1 is low

33
Q

What happens to the FEV1/FVC ratio in restrictive lung disease and why is this?

A

Normal >70%, both the FVC and FEV1 will be reduced, making the ratio normal

34
Q

What does parasympathetic innervation do to the bronchi?

A

Causes bronchoconstriction

35
Q

What does sympathetic innervation do to the bronchi?

A

Causes bronchodilatation

36
Q

In obstructive lung disease is inspiration or expiration more difficult and why?

A

Expiration is more difficult than inspiration because during expiration the pleural pressure rises causing compression of the alveoli and airways
Diseased airways are also more likely to collapse

37
Q

What happens if a patient had restrictive airways disease on top of obstructive?

A

The problem of expiration becomes worse because the patient will have decreased elastic recoil of the lungs e.g. COPD - obstructed airway and emphysema (restrictive)

38
Q

What is pulmonary compliance?

A

Measure of the effort that has to go into stretching or distending the lungs
The less compliant the lungs are, the more work is required to produce a given degree of inflation

39
Q

What can cause decreased pulmonary compliance?

A

Pulmonary fibrosis, pulmonary oedema, lung collapse, pneumonia, absence of surfactant

40
Q

What does decreased pulmonary compliance cause clinically and what pattern would it show on spirometry?

A

Decreased pulmonary compliance means greater change in pressure is needed to produce a given change in volume i.e. lungs are stiffer. This causes shortness of breath, especially on exertion
Decreased pulmonary compliance may cause a restrictive pattern on spirometry

41
Q

What could cause increased pulmonary compliance?

A

If the elastic recoil is lost, occurs in emphysema. Patients have to work harder to get the air out of the lungs - hyperinflation of lungs
Compliance also increases with increasing age

42
Q

When does the work of breathing increase?

A

Pulmonary compliance decreased, airway resistance increased, elastic recoil, decreased, need for increased ventilation

43
Q

What is the anatomical dead space?

A

Inspired air that remains in the airways where it is not available for gas exchange

44
Q

What is the pulmonary ventilation?

A

Volume of air breathed in and out per minute

Tidal volume x respiratory rate = 6L/min

45
Q

What is the alveolar ventilation?

A

Volume of air exchanged between the atmosphere and alveoli per minute
(Tidal volume - anatomical dead space) x respiratory rate = 4.2L/min

46
Q

How is pulmonary ventilation increased?

A

By increased both the depth and rate of breathing but due to the dead space it is more beneficial to increase the depth of breathing

47
Q

What is ventilation and perfusion?

A

Ventilation is the rate at which gas is passing through the lungs
Perfusion is the rate at which blood is passing through the lungs

48
Q

Blood flow (perfusion) and ventilation vary from the bottom to the top of the lungs. What is the result of this?

A

The average arterial and alveolar partial pressures of oxygen are not exactly the same.
This is usually not significant but can be in disease

49
Q

What is the alveolar (not anatomical) dead space?

A

Ventilated alveoli which are not adequately perfused with blood are considered as alveolar dead space
In healthy people, this is very small and of little importance but in disease the alveolar dead space could increase significantly

50
Q

What happens as a result of increased perfusion?

A

Accumulation of carbon dioxide in alveoli due to increased perfusion decreases airway resistance leading to increased airflow

51
Q

What happens as a result of increased ventilation?

A

Increase in alveolar oxygen concentration due to increased ventilation causes pulmonary vasodilation which increases blood flow to match larger airflow

52
Q

When is perfusion greater than ventilation?

A

When carbon dioxide levels in the alveoli increase or when the oxygen levels in the alveoli decrease

53
Q

When is ventilation greater than perfusion?

A

When carbon dioxide levels are low or oxygen levels are high in the alveoli

54
Q

What happens to the pulmonary and systemic circulation when there is decreased oxygen?

A

Pulmonary arterioles constrict and systemic arterioles dilate

55
Q

What happens to the pulmonary and systemic circulation when there is increased oxygen?

A

Pulmonary arterioles dilate and systemic arterioles constrict

56
Q

What 4 factors influence the rate of gas exchange across the alveolar membrane?

A
  1. partial pressure of oxygen and carbon dioxide
  2. diffusion coefficient for oxygen and carbon dioxide
  3. surface area of alveolar membrane
  4. thickness of alveolar membrane
57
Q

What is Dalton’s law of partial pressures?

A

The total pressure exerted by a gaseous mixture = The sum of the partial pressures of each individual component in the gas mixture

58
Q

What is the partial pressure of a gas?

A

The pressure that one gas in a mixture of gases would exert if it were the only gas present in the whole volume occupied by the mixture at a given temperature

59
Q

How is partial pressure of oxygen in the alveoli calculated?

A

PAO2 = PiO2 - (PaCO2/0.8)
PAO2 - partial pressure of O2 in alveoli
PiO2 - partial pressure of O2 in inspired air
PaCO2 - partial pressure of CO2 in arterial blood

60
Q

What is the difference in diffusion coefficient between oxygen and carbon dioxide?

A

Diffusion coefficient for CO2 is 20 times that of O2

61
Q

What is the typical gradient between alveolar and arterial PO2?

A

A small gradient between PAO2 and PaO2 is normal but a big gradient indicates problems with gas exchange in the lungs or right to left shunt in the heart

62
Q

What is Fick’s law of diffusion?

A

The amount of gas that moves across a sheet of tissue in unit time is proportional to the area of the sheet but inversely proportional to its thickness

63
Q

What type of cells are within the alveolar walls?

A

A single layer of type I alveolar cells

64
Q

The amount of a given gas dissolved in a given type and volume of liquid (blood) at a constant temperature is proportional to the partial pressure of the gas in equilibrium with the liquid. What law is this?

A

Henry’s law

65
Q

How is most O2 transported in the blood and what is the normal O2 concentration in arterial blood?

A

Mostly transported in the blood bound to Hb

Normal O2 concentration in the arterial blood is about 200ml/L

66
Q

Oxygen in present in the blood in 2 forms, what are these forms?

A

Bound to Hb and physically dissolved

67
Q

When might oxygen delivery to the tissues be impaired?

A

Respiratory disease, heart failure or anaemia

68
Q

How does respiratory disease impair oxygen delivery to tissues?

A

Decreases arterial PO2 and hence decreases Hb saturation with O2 and O2 content of the blood

69
Q

How does anaemia impair oxygen delivery to tissues?

A

Decreases Hb concentration and hence decreases O2 content of the blood

70
Q

How does heart failure impair oxygen delivery to tissues?

A

Decreases cardiac output

71
Q

What is the Bohr effect?

A

A shift of the oxygen haemoglobin dissociation curve to the right
Increased release of O2 by conditions at the tissues e.g. increase in hydrogen ions (decrease in pH), increase in carbon dioxide, increase in temperature and an increase in 2,3-BPG